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One year ago, an article appeared in the April 2009 issue of Case In Point titled “Is Your Job Putting You at Risk?” The article’s subject matter—the issue of multistate licensure—garnered a fair amount of attention over the ensuing few months. Throughout the past year, a tremendous groundswell of attention directed to nursing licensure has grown within the case management community.

The concept of multistate licensure has captivated the interest of nurse case managers across the country. The background of licensure is important to understanding what’s currently at stake. As many of us know, nursing licenses are state-regulated. For many years the only way a nurse could obtain a license in another state was to apply for a license through endorsement, pay a fee, and wait several weeks to several months for the new license. In most cases, a new license was required because the nurse relocated to another state.

However, times have changed. Providing nursing case management services across state lines has become commonplace due to changes in our health care system, which have led to an increasingly mobile nursing workforce. Provider delivery systems like supra-state health care organizations and health care payer strategies such as telephonic case and disease management have become regular entities and initiatives.

To address these profound changes in the nursing workforce, the National Council State Boards of Nursing (NCSBN) proposed a solution in the late 1990s that is known as the Nurse Licensure Compact, or NLC. This legal compact was developed to address a fragmented licensure process and to assist nurses in securing safe employment in new areas of health care.

The NLC is a mutual-recognition pact based on model legislation enacted through a state’s legislative process. The NLC allows for recognition of a nurse’s “home state” license by all other “party” states in the compact. This allows nurses in some states to work either on-site or electronically in all other states in the compact without the need to fill out applications, pay fees or wait for another state’s licensure process. To date, 24 states have passed legislation to join the NLC.

According to data collected by the NCSBN, the compact has been working well since its inception in 2000. Positive outcomes include increased discipline and information sharing among compact state boards of nursing, streamlined regulatory processes, improved nursing mobility, and clarification of the right to practice for many nurses currently working in telenursing and/or interstate nursing practice. These findings as well as other related information can be found at www.ncsbn.org.

A Licensure Task Force

The Case Management Society of America is proactive in government affairs, particularly the legislative process as it affects case managers nationwide. Because significant change requires the concentrated efforts of dedicated professionals, CMSA’s public policy committee (PPC) has become an increasingly effective force for change.

Due to serious concerns regarding nursing licensure in the case management arena, supporting expansion of the NLC became one of the primary initiatives of the PPC. In early 2009, the decision to dedicate additional time and resources toward a multistate licensure initiative was spearheaded by then-PPC chair and current CMSA president Peggy Leonard. Carol Gleason now leads this influential committee.

The CMSA MSL Task Force was created to raise awareness about the multistate licensure concept and the legal, regulatory vehicle for change: the Nurse Licensure Compact. The MSL Task Force serves as a resource for individuals interested in moving the NLC initiative forward, and it is a springboard for collaborative efforts with other stakeholders.

At the time this article was written, the MSL Task Force had more than 160 contacts representing 36 states. Monthly teleconferences have been well attended, serving as a sounding board and information sharing for individuals, from novice to expert, in terms of multistate licensure and the legislative process required to enact the NLC.

As of March 2010, five states have active NLC legislation: Alaska, Georgia, Illinois, Minnesota and New Jersey. Legislation is in different stages in each state, and the outcome of the 2010 legislative sessions is yet to be realized. Passage of NLC legislation through state governments has taken anywhere from 30 months to an average of seven years, according to NCSBN.

Active Stewardship Guides NLC Legislation

There are several states that have excellent case management leadership in the forefront of the NLC initiative. In Minnesota, Judy Santiago has been actively seeking support and endorsements for four years to ensure compact legislation is brought in front of the Minnesota legislature. Santiago is a tireless advocate for NLC, and has been joined this year by Alison Johnson.

In Florida, individuals such as Kathleen Jarvis, Nancy Murphy, Laurie Davis, Anne Llewellyn and Marilyn Doty have been engaged in grassroots efforts to bring the NLC before Florida’s legislature. These case managers found each other through the MSL Task Force and are now coordinating efforts statewide in Florida.

Public Policy Committe member Mary Hughes, who brings a wealth of experience in the legislative process to the table, is leading NLC efforts in Washington state. Similarly, PPC and CMSA board member Connie Sunderhaus is leading the charge in Illinois, where she is joined by Wendy Connors and Sue Baxter-Pflederer.

New Jersey has strong leadership in Pat Agius, Pam Molinari, Donna Ridolfino, and MSL Task Force Chair Jose Santoro. A new team in Alaska headed by Joann Young has recently become active in an NLC initiative in Alaska. 

Georgia has Pat McCutchen, Susan Dunn and Laurie Russell leading the NLC charge, while Margo MacRobert in Oklahoma has opened dialogue with her state’s Board of Nursing Executive Director and is poised to move the NLC issue forward in that state. 

It is my hope that other nurse case managers will join this group of dedicated leaders who understand the need for multistate licensure and have committed themselves to actively supporting NLC in their states. These individuals and others like them make the difference between hoping for and achieving multistate licensure across the United States. I look forward to having a higher number of compact states than noncompact states—two more will make that a reality.

Moving Forward

Phase II for the MSL Task Force will focus on developing collaborative relationships with professional organizations that support the NLC.

There are many professional organizations on record as being in support of the NLC, including the American Association of Occupational Health Nurses, the American Association of Ambulatory Care Nursing, the State Alliance for e-Health of the National Governors Association Center for Best Practices, the American Organization of Nurse Executives, the Emergency Nurses Association, and the U.S. Department of Commerce. This is not an all-inclusive list. Please find additional supporting organizations on the NCSBN website.

For more information, including the CMSA Position Paper (revised in 2009), articles and template letters of support for the NLC, check out the CMSA multistate licensure webpage located under the “Policy Makers” tab at www.cmsa.org.

Carol Smith, RN-BC, MSN, has worked in case management for 15 years and currently provides telephonic case management services. She is ANCC certified and served on the ANCC Content Expert Panel for two terms. ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )